Dr. Prager agrees that advanced practice PAs and nurse-practitioners are invaluable to a surgical team because they know the routines and are committed and efficient. At the University of Michigan Hospital, four PAs provide first and second assistance for cardiothoracic surgery. They are more skilled in harvesting arteries endoscopically than the junior-level residents, he said.
An advanced practice team of 10 PAs and nurse-practitioners manages the floor, generally covering 3032 patients and freeing residents from rounds. Dr. Prager sees this as a boon to both the hospital, which gets more efficient patient care, and the residents, who spend more time on education.
A similar evolution has taken place at St. Joseph Mercy Hospital in Ann Arbor. Before workweek restrictions were in place, the cardiothoracic service had seven PAs. With the reduction in residents' hours, the hospital had to double that number to cover critical care 24 hours a day, 7 days a week, and to assist both during and after operations, said LaWaun Hance, a PA-C and education coordinator for the cardiothoracic PA residency program at St. Joseph.
The PAs provide first and second assists, including endoscopic vein harvest, and if necessary they open or close the chest, said Ms. Hance.
The increaseduse of midlevel providers isa positive developmentfor residents. DR. PRAGER